Diabetic Retinopathy

Since the establishment of the English National Screening Programme for Diabetic Retinopathy and similar programmes in Scotland, Wales and Northern Ireland, annual photographic retinal screening is offered to all people with diabetes over the age of 12. The national programmes are responsible for the training, accreditation and quality assurance of local screening programmes. The detection of referable retinopathy or an inability to obtain gradable screening images triggers referral to the hospital eye service (HES).

The aim of the screening process and management of diabetic retinopathy in the HES is the prevention, detection and treatment of sight-threatening maculopathy and proliferative retinopathy. Good control of blood sugar, blood pressure and blood lipids reduces the risk of developing sight-threatening retinopathy and oral fibrates reduce the risk of progression of diabetic maculopathy. It is therefore important that there is close liaison between diabetic retinopathy services, diabetologists and general practitioners, particularly regarding the care of patients at high risk of developing sight-threatening retinopathy.

Timely delivery of laser retinal photocoagulation remains the mainstay of treatment for diabetic maculopathy and proliferative retinopathy. However, diffuse diabetic maculopathy may respond relatively poorly to laser treatment and intravitreal injections of ranibizumab or bevacizumab may be more effective at stabilizing or improving vision on their own or in combination with laser photocoagulation. Research to determine the optimum frequency and duration of injections is ongoing. Vitreoretinal surgery may be required for a minority of patients who develop severe diabetic eye disease.

Good communication between diabetic retinopathy screening programmes and the hospital diabetic retinopathy services to which they refer is essential. This is frequently the weakest link in the services for patients with diabetic retinopathy. Screening programmes need to be notified regularly of the status of patients attending hospital diabetic retinopathy clinics so that the fail-safe database can be kept up to date. Hospital diabetic retinopathy clinics should have access to retinal screening images in order to determine the optimal frequency of follow-up.